News

Health Net modifying exchange/mirror products

November 03, 2014

Area(s) of Interest:

Health Net recently announced changes to its exchange/mirror products offered for 2015. In a notice mailed to select physicians, the insurer said it will be offering an Exclusive Provider Organization (EPO) and a Health Care Service Plan (HSP) for its individual exchange/mirror products effective January 1, 2015.

Though not explicitly stated in the notice, the California Medical Association (CMA) has confirmed the insurer will not be offering a PPO product in the individual exchange/mirror market.

The EPO will be called PureCare One and the HSP will be called PureCare. Patients will be able to select one of these new plans during the next Covered California open enrollment period, which begins November 15. Both of the new products will utilize a narrowed provider network.

The new EPO and HSP products function similar to an HMO in that they do not offer out of network benefits. Additionally, individuals who select the PureCare HSP will be required to select a primary care physician (PCP). The Purecare One EPO plan, however, does not require individuals to select a PCP.

Health Net will offer the PureCare HSP and HMO products in Southern California counties and will offer the PureCare One EPO product in the other counties in which it offers an exchange/mirror product. The payor has confirmed there are no changes to its HMO product for 2015. Health Net’s 2015 individual exchange/mirror products will be as follows:

Individual Exchange Rating Region / County

Exchange Products

2 – Napa, Sonoma, Solano and Marin

EPO

4 – San Francisco

EPO

5 – Contra Costa

EPO

7 – Santa Clara

EPO

8 – San Mateo

EPO

9 – Santa Cruz

EPO

10 – San Joaquin, Stanislaus, Merced, Tulare

EPO

14 – Kern

EPO

15 – Los Angeles (Northern: High Desert/Antelope Valley and Eastern metropolitan half of county, including San Gabriel Valley)

HSP and HMO

16 – Los Angeles (Western and Downtown Los Angeles County, covering the central and southern metropolitan portions of the county, excluding Catalina Island)

HSP and HMO

17 – San Bernardino and Riverside

HSP and HMO

18 – Orange

HSP and HMO

19 – San Diego

HSP and HMO

In addition to the above changes for the individual market, Health Net has advised CMA it will begin offering the EPO product along with the PPO product in the SHOP market, which is offered in all counties.

Physicians who received the notice were also advised that they were automatically being opted into the provider networks for Health Net’s new products and will be paid at 100 percent of their current contracted PPO/EPO rates.

Practices who did not receive the notice are encouraged to confirm their participation status with Health Net by calling Provider Services at (800) 641-7761 as Health Net’s online directory had not been updated to reflect the new products at the time of publication.

Health Net has advised the California Medical Association that it will still offer the individual PPO product, however individuals who select that product will not be eligible to receive Covered California premium subsidies.

Practices with questions about the notice can contact Health Net Provider Services Center at (800) 641-7761.